CDC: Cutting Smoking in Subsidized Housing Would Save $521M Annually
Eliminating the ability to smoke in U.S. subsidized housing would save approximately $521 million each year in health care, renovation and fire-related costs, according to the U.S. Centers for Disease Control and Prevention (CDC). This includes public housing and rental assistance programs. Secondhand smoke can be especially problematic in multi-unit buildings with at-risk populations and smoking in common rooms. "Many of the more than 7 million Americans living in subsidized housing in the United States are children, the elderly or disabled," said Tim McAfee, MD, MPH, director of the Office on Smoking and Health at CDC. "These are people who are most sensitive to being exposed to secondhand smoke. This report shows that there are substantial financial benefits to implementing smoke-free policies, in addition to the health benefits those policies bring." Read more on tobacco.

HHS Campaign to Promote Breastfeeding by African American Mothers
The new It’s Only Natural public education campaign from the U.S. Department of Health and Human Services will work to raise awareness of the importance of breastfeeding among African American women, according to Surgeon General Regina M. Benjamin, MD, MBA. “One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed,” she said in a release. “By raising awareness, the success rate among mothers who want to breastfeed can be greatly improved through active support from their families, their friends and the community.” While overall 80 percent of U.S. women start out breastfeeding, that number is only 55 percent for African American women. The new campaign provides material specifically targeting African American women and giving them the information and encouragement they need to start and continue breastfeeding. Read more on maternal and health disparities.

U.S. Infant Mortality Rates Down; More Improvement Still Needed
Improvements in prenatal care and a reduction in elective deliveries helped cut the U.S. infant mortality rate by 12 percent from 2005 to 2011, according to a new study in the NCHS Data Brief. The National Center for Health Statistics (NCHS) said the rate was down to 6.05 deaths per 1,000 live births in 2011 from 6.87 in 2005. The rate of death from SIDS also dropped 20 percent over the period. Still, study author Marian MacDorman, PhD, an NCHS statistician, said more work is needed, noting that “preterm birth rates are much higher than in other countries, and the same is true with infant mortality" and that "[i]nfant mortality among blacks is about twice what it is for white women,” according to HealthDay. Jeffrey Biehler, MD, a pediatrician at Miami Children's Hospital, said that we "need to continue to advocate for prenatal care for every woman, and make sure they are educated so they know to seek care as early as possible and avoid smoking and alcohol and other things that put them and their babies at risk.” Read more on maternal and infant health.

CDC, SAMHSA and Red Cross Resources Help Individuals and Communities Cope with Disaster
Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages. CDC’s “Tips for Self Care” includes advice on dealing with stress and suggestions for connecting socially after a traumatic event, avoiding drugs and alcohol, as well as links to SAMHSA’s disaster distress helpline  which can be accessed by phone, text, twitter and Facebook. SAMHSA’s site also includes resources for students, parents, teachers, caregivers, children, first responders and health professionals.

Following the explosions, families and friends found that cell phone and in some cases even texting communication was jammed, making it difficult for people to know whereabouts of those involved in the explosion. The American Red Cross offers a free service called the Safe and Well website which is a central site for people in disaster areas in the United States to register their current status, and for their loved ones to access that information. The Red Cross says the site helps provide displaced families with relief and comfort during a stressful time. The site is easy to use:

• If you are currently being affected by a disaster somewhere in the United States, click List Myself as Safe and Well, enter your pre-disaster address and phone number, and select any of the standard message options.
• If you are concerned about a loved one in the United States, click Search Registrants and enter the person’s name and pre-disaster phone number OR address. If they have registered, you will be able to view the messages they have posted.

The site is available 24 hours a day, 365 days a year and is accessible in both English and Spanish. Read more on preparedness.

Mortality Rates Highest at Small Rural Hospitals
A new study by researchers at the Harvard School of Public Health (HSPH) finds that a failure to stay up to date in the treatments they provide may be a factor in climbing death rates at rural hospitals. The study appeared in the JAMA. The HSPH researchers reviewed data from small, rural hospitals that receive government reimbursements and are exempt from participation in national quality improvement programs. The researchers looked at data on 10 million Medicare patients who were admitted to these small rural hospitals or other hospitals with a heart attack, congestive heart failure, or pneumonia—and compared 30-day mortality rates for each of the three conditions over a nine-year period. While ten years ago, mortality rates for each of these conditions were about the same at hospitals, the researchers found that between 2002 and 2010, mortality rates at CAHs increased at a rate of 0.1% per year, while at non-CAHs they decreased 0.2% per year. By 2010, CAHs had higher overall mortality rates—13.3% versus 11.4% at non-CAHs. “Small rural hospitals are being left behind,” says Karen Joynt, MD, MPH, the lead author on the study. “By creating a separate category for these hospitals, we’ve really left them out of many of the advances in medical care over the past decade, and we need systems-level solutions to help improve healthcare in these rural areas.” Read more on health disparities.

High Resting Heart Rate Indicates Increased Risk of Early Death
Faster than normal heart rates—even in men who exercise—could indicate a higher risk of early death, according to a new study in the journal Heart. While previous studies have shown a connection between heart rate and life expectancy, this study looked specifically at whether that was also true for healthy people who got regular exercise; the results indicate that resting heart rate is a risk factor independent of other health markers. Each 10-beat-per-minute resting heart rate increase corresponded to a 16 percent increase in the likelihood of death. Gregg Fonarow, MD, a professor of cardiology at the University of California, Los Angeles, said there are ways to improve resting hear rate. "Increasing physical activity and decreasing periods of sitting can lower heart rate and lower cardiovascular risk," he said, adding that stopping smoking can also lower heart rate. Read more on heart health.

U.S. Spends More on Dementia than Either Heart Disease or Cancer
At as much as $215 billion annually, the cost of dementia care in the United States is now higher than the costs for either heart disease or cancer, according to a new study in the New England Journal of Medicine. That includes the costs for both professional and family care. And the costs will only rise as the population ages, with as many as 14 million Americans expected to have Alzheimer’s by 2050, according to HealthDay. "It's not a happy situation," said lead researcher Michael Hurd, a senior principal researcher at the nonprofit research institute RAND. "A lot of the costs fall on families, and right now, there's no solution in sight." Read more on aging.

Brain Stimulation Could ‘Turn Off’ Compulsive Drug-Taking
Targeting a specific region of the brain could help turn off addictive behavior, according to a new study in the journal Nature. Researchers at the Intramural Research Program of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the University of California, San Francisco were able to reduce compulsive cocaine-seeking in rates by stimulating their prefrontal cortexes. They believe this technique could ultimately be used to stop compulsive drug-taking in humans. “We already knew, mainly from human brain imaging studies, that deficits in the prefrontal cortex are involved in drug addiction,” said NIDA Director Nora D. Volkow, MD. “Now that we have learned how fundamental these deficits are, we feel more confident than ever about the therapeutic promise of targeting that part of the brain.” Read more on addiction.

Study: Black Men Wait Longer to Begin Prostate Cancer Treatment
Black men wait longer than white men to begin prostate cancer treatment after diagnosis, according to a new study in the journal Cancer. Researchers at the University of North Carolina found a delay of seven days with early prostate cancer and nine days with aggressive prostate cancer. As the study looked at Medicare data, the researchers know all the men were insured so it wasn’t a lack of insurance stopping them from seeking treatment earlier. Multiple studies also show that black men in general are less likely to be screen for cancers and to receive aggressive treatment. "Now we have shown that African American patients also wait longer for treatment,” said study leader Ronald Chen, MD, an assistant professor at UNC's Lineberger Comprehensive Cancer Center. “I think all of these disparities together add up to contribute to worse long-term survival outcomes for African American patients." Read more on health disparities.

Expansion of Health Insurance Coverage Could Lead to Physician Shortage
A new study in Health Affairs finds that expansion of insurance coverage under the Affordable Care Act could increase demand, on average, for primary care physicians more than 5 percent above the current number of available doctors. It also found that seven million people live in areas where the demand will exceed the supply of primary care providers by more than 10 percent. The researchers say the study emphasizes the need to promote policies that encourage more primary care providers to practice in areas where shortages will be very high. Read more on health disparities.

Institute of Medicine Launches ‘Roundtable on Population Health Improvement
The Institute of Medicine has launched a Roundtable on Population Health Improvement to provide opportunities for experts on education, urban planning, medicine, public health, social sciences and other fields to make recommendations on improving the nation’s health. "The evidence is now clear that broader social and environmental factors play major roles in a person's likelihood to have a low birth weight baby—a risk for many serious health problems— or die of a heart attack or complications from diabetes," said roundtable co-chair David Kindig, Emeritus Professor of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison. "That's why it's essential to engage all these sectors—education, housing, transportation, community organizations, and business among others— in efforts to improve health outcomes." The issues the roundtable will address include expanding reimbursement to include more nonclinical, population-based interventions; reorienting the relationship between clinical medicine and public health in ways that will benefit population health outcomes; and engaging professionals from nonhealth fields in health improvement efforts. Read more on community health.

CDC: 11% of Daily Calories for Adults Comes from Fast Food
From 2007 to 2010 approximately 11 percent of the calories in American adults' daily diets came from fast food, according to a report from the U.S. Centers for Disease Control and Prevention. While high, the rate was down from 2003 to 2006, when about 13 percent of daily calories came from restaurants such as McDonald's, Burger King, Wendy's and Pizza Hut. "The good news from this study is that as we get older, perhaps we do get wiser and eat less fast food," said Samantha Heller, a clinical nutritionist at the NYU Center for Musculoskeletal Care in New York City. "However, a take-home message is that the study suggests that the more fast food you eat, the fatter you get." Read more on nutrition.

The Robert Wood Johnson Foundation has announced the nominees for its 2012 Year in Research campaign — a look at the most influential Foundation-supported research that has changed the field of health and health care in a valuable way. There are 20 finalists, selected for being the most popular research articles among RWJF.org readers. Now it’s time to choose the “Final 5.”

UPDATE: The winner has been chosen! Congratulations to the research team behind the Graduated Driver Licensing Decal Law. Go here to see the full rankings and read interviews with all five finalists.

Graduated Driver Licensing Decal Law: Effect on Young Probationary Drivers
Teen drivers may not like it, but New Jersey's pioneering graduated driving license decal law is estimated to have prevented more than 1,600 crashes. New Jersey, which already had rigorous graduated driving laws (GDLs), enacted in April 2009 the nation’s first law to require probationary drivers to display small decals on their license plates, which allowed for more rigorous enforcement of restrictions on young drivers, such as bans on cell phone use. Researchers analyzed the success of the law by linking information from two databases: one for licensing and registration, and one for crash records. The law appears to have enhanced police officers’ ability to enforce GDLs, as well as probationary driver’s willingness to comply with them. Read more about the research and its effects in “Keeping Teen Drivers Safe Through Public Health Law: Allison Curry Q&A.”

Citric acid-based drinks have been linked to devastating tooth erosion, especially in Central Appalachia where the drinks are widely consumed by people of all ages. The issue was selected for a five-minute “Critical Opportunities” presentation that garnered more votes than any other issue in the session at the most recent Public Health Law Conference. This year, the issue has moved to a general session on the main day of the Public Health Law Research (PHLR) Annual Meeting, as an emerging issue in public health law. Priscilla Harris, JD, an associate professor with the Appalachian School of Law in Grundy, Va., will present “Finding Legal Interventions to Impact Purchase and Consumption of Sugar-Sweetened Beverages and Citric Acid Drinks: Trying to undo the damage of the Dew.”

According to the American Dental Association, 65 percent of West Virginia's children ages three through seven suffer from tooth decay—and near-constant sipping of Mountain Dew and other citric acid-based drinks plays a role. Harris, together with Dana Singer, JD, a program developer and researcher at the Mid-Ohio Valley Health Department and Mary Beth Shea, a dental hygienist with the health department, spoke at an information session to the Mid-Ohio Valley Board of Health a few weeks ago to present the research they have worked on to show the damaging health effects of the beverages for the people of the region. NewPublicHealth spoke with the three public health professionals just before the PHLR annual meeting began.

NewPublicHealth: What research are you working on to look at the impact of citric acid on tooth health?

Priscilla Norwood Harris: We conducted surveys to determine purchase and consumption patterns for sugar-sweetened beverages and citric acid drinks. We also interviewed and sent surveys to dentists in Central Appalachia about their perceptions of oral health problems in the region. We also went to five clinics that offer medical, dental and vision care to low-income people, and asked patients about these drinks. In addition, have almost 2,000 surveys of students in grades K through 12. We have also reviewed journal articles, many from Europe, that examine the issue of dental erosion. While it’s under the radar here in America, the studies we’ve reviewed are making the connection between dental erosion and the citric acid in drinks.

A lot of the attention in the U.S. has been focused on the sugar in these drinks and their contribution to obesity as well as the sugar with regard to oral health and cavities. Unfortunately, the acids in these drinks and the connection to dental erosion have been almost ignored. “Mountain Dew Mouth,” a term used in Central Appalachia for severely damaged teeth, involves the acids in these drinks, which can take away the tooth’s enamel.

Mary Beth Shea: From a dental health professionals’ perspective, we see a high number of adults who have said they didn’t have a clue that the beverages they’re consuming are causing the damage in their mouth and they haven’t had money for dental care.

The state of Maryland recently passes legislation to address health disparity issues through “health enterprise zones.” The legislation allows local non-profits, health agencies, and local health providers to work together to address this critical issue through innovative public health strategies including tax incentives, financial awards and capital improvement funding for physicians and health care organizations.

Lt. Governor Anthony Brown of Maryland played a key role in establishing the zones, and spoke about them in session at yesterday’s GOVERNING Summit on Healthy Living. Lt. Governor Brown gave some important background on his personal push to establish the health enterprise zones, explaining that his father was a doctor who “taught a lesson of service.” For decades, he said his father saw and cared for patients in some of the poorest neighborhoods in New York. “I saw the file cabinets of unpaid invoices. My father taught me we have a responsibility to serve and care for our neighbors.”

Brown told the audience that, “as we look at health reform, there are real opportunities to address disparities in health. As we expand access, we need to increase quality and equity. I believe we can eliminate health disparities.” NewPublicHealth had the opportunity to speak with Lt. Governor Brown about health enterprise zones.

NewPublicHealth: Is this the first time that a health enterprise zone has been implemented?

Health disparities and social equity were key issues addressed at last month’s American Public Health Association (APHA) annual meeting. Angela Glover Blackwell, founder and CEO of PolicyLink, a national research and action institute whose goal is to advance economic and social equity, participated in the APHA president’s panel on the topic, where a key part of the discussion focused on the language used to discuss health disparities in the United States.

NewPublicHealth followed up with Angela Glover Blackwell to get her insights on the language of health disparities.

NewPublicHealth: During the panel at the APHA meeting, you talked about the need to be mindful of the language we use when talking about improving health for all Americans. How should we be characterizing the issues?

Angela Glover Blackwell: It is certainly good to see that the health world, public health and beyond, is talking about health disparities. Because for many years this was not anything that people talked about and it was not a topic at the American Public Health Association or any of the other big main stream meetings where health professionals gathered. So it’s a good thing that people have begun to talk about health disparities.

But, health disparities really talks about things being unequal. That’s what disparity means—unequal, different. But I don’t think that disparity captures what the condition is, nor does it suggest what the solution is. What I have heard others say and I have taken it on myself is the term health inequities, because the term “inequities” suggests unjust, unfair, and not just different. When you call them health inequities you focus on a societal problem that needs to be corrected, not just studied. The goal becomes achieving health equity, just and fair health outcomes.

It’s time that we recognize that we have unequal, unjust, unfair health outcomes and that they are related to race, and income, and place and we need to get sharp strategies that move us towards being able to help all people reach their full potential.

NPH: Where do we need to take the conversation from here?

Study: Graphic Warning Labels on Tobacco Effective on At-risk Populations
The U.S. Food and Drug Administration’s graphic warning labels on tobacco products may be more effective than written labels at convincing less-educated, lower-income populations of the dangers of tobacco use, according to a new study in the American Journal of Preventive Medicine. This population is also linked to higher smoking rates and high rates of death and disease related to tobacco. The labels show graphic images of the results of tobacco use—from the effects of cancer to death. "Research on cigarette warnings in the United States and other countries has repeatedly shown that pictures work better than text," said James Thrasher, MD, an associate professor in the department of health promotion, education and behavior at the University of South Carolina in Columbia. "Our research supports this finding while also showing what tobacco researchers have assumed for a while—that warnings with pictures work particularly well among smokers with low levels of literacy." Read more on tobacco.

Clinton Foundation to Combat Health Disparities, Preventable Illness
The William J. Clinton Foundation’s Clinton Health Matters Initiative is partnering with major corporations in an effort to combat health disparities and preventable illness. Beginning with Verizon, General Electric Co., Tenet Healthcare Corp. and NBC/Universal, the program will implement and support workplace and community wellness programs. The efforts will include free exercise classes, walking groups in poor neighborhoods, farmers' markets in underserved areas and smoking-cessation programs, according to Reuters. Read more on health disparities.

Cost a Factor When Doctors Choose Heart Disease Treatments
Doctors are increasingly considering the financial costs when deciding exactly how to treat heart disease, according to attendees at an annual scientific meeting of the American Heart Association (AHA). The AHA believes the annual cost of treating heart disease—the number one cause of death in the United States—will rise to $800 billion by 2030. Factors include rising costs of drugs and equipment; to insurance reimbursements; and changes anticipated under the Patient Protection and Affordable Care Act. "We have an unsustainable economic model in healthcare delivery in the U.S.," said Elliott Antman, MD, professor of medicine at Harvard Medical School and chairman of the AHA Scientific Sessions Committee, according to Reuters. "We all have to be conscious of ways we can be more cost efficient, and that includes understanding what the big breakthroughs mean in terms of cost." Multiple studies presented at the meeting covered the overlap between quality patient care and cost. Read more on heart health.

Inspired by the 2012 American Public Health Association (APHA) Annual Meeting, the Robert Wood Johnson Foundation recently talked with a range of national thought leaders to discuss what’s needed—and what works—to achieve better health.

Today, we're featuring video interviews with Ron Chapman, MD, MPH, Director of the California Department of Public Health.

Chapman spoke with us about the current national opportunity to transform public health by making quality improvement and performance management “a way of life.”

He also discussed how collaborating with city planners, the business community, transportation officials and others can enable us to build healthier communities from the ground up.